Laserfiche WebLink
PERMITTEE NAME/ADDRESS ;bulade Far•&.0ameib?rarion if ixf earn) <br />NAME <br />ADDRESS <br />_A 57 <br />FACILITY HOR I %'-A,! !-1 ! f <br />LOCATION 1 A R ] <br />LANt":t= WADE, MINE. MAP4AGFF <br />NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES) <br />DISCHARGE MONITORING REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />YEAR MO DAY YEAR MO DAY <br />FROM TO <br />Form Approved. <br />OMB No. 2040-0004 <br />(Sly, r. <br />F - FINAL MT-4 T K5 <br />5t`t?rM £ FvF DIRNG TO TUTTLE DRAW <br />NOTE: Read Instructions before completing this form. <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO, FREQUENCY <br />OF SAMPLE <br /> EX TYPE <br /> ANALYSIS <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT N iN I MUf l <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT .. <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT _ _ <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT • ,_ . . <br /> REQUIREMENT = <br />NAMEITITLE PRINCIPAL EXECUTIVE OFFICER I certify under penalt y of lam that this document and all attachments Wert <br />d <br />s TELEPHONE DATE <br /> Wim in mxordame with a ryslrm drsigrx <br />prepared under my dirvenon or super <br />_ to assure that qualified pemmnrl properly gather and e, aluate the information -r <br />_ submitted. Based on my inquiry of the person or perxms who manage the system. <br /> or those Persons directly re,gmmsibie for gathering the information. the information - <br /> and com <br />st of m <br />knowled <br />e and lelief <br />Irma <br />accurate <br />lete <br />b <br />itt <br />d i <br />t <br />th <br />b <br /> <br />- g <br />• <br />, <br />. <br />p <br />. <br />su <br />m <br />o <br />e <br />e <br />y <br />e <br />s. <br />SIGNATURE OF PRINCIPAL EXECUTIVE <br />- <br />TYPED OR PRINTED' I am aware that there are significunt penalties for submitting false information. <br />including the possibility of fine and imprisonment for knowing siolutiuns. OFFICER OR AUTHORIZED AGENT <br /> <br />REA NUMBER <br />A <br />CODE <br /> <br />YEAR <br /> <br />MO <br /> <br />DAY <br />COMMtNIS ANU txYLANAIIUN OF ANT VIVLAIIVrvJ (Yfeference an AflBCn11rent9 nern/ <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. Tins is ii 4-part fflrni. PAGE OF